Provider Demographics
NPI:1043442890
Name:STREET, JENNA (MS, ATC, PES)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLYMPIC PLZ
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5780
Mailing Address - Country:US
Mailing Address - Phone:719-866-2548
Mailing Address - Fax:719-632-9282
Practice Address - Street 1:1 OLYMPIC PLZ
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5780
Practice Address - Country:US
Practice Address - Phone:719-866-2548
Practice Address - Fax:719-632-9282
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer